Linking family and intimate partner relationships to chronic pain: An application of the biobehavioral family model.

INTRODUCTION: Research is needed to determine mechanisms of effect linking family relationships and chronic pain for adults. Guided by the Biobehavioral Family Model (BBFM), the present study examined indirect effects between a negative family emotional climate and chronic pain disease activity, as mediated by biobehavioral reactivity. METHOD: Data for this study are from the Midlife Development in the United States; specifically, a subsample of participants who reported experiencing chronic pain (n = 1,461, ages 32-84). Participants self-reported family strain, biobehavioral reactivity (i.e., anxiety, depression), and chronic pain disease activity (i.e., pain interference, global health). A subsample of participants (n = 1,070) completed an intimate partner strain measure, indicating they were married/in a committed relationship. Structural equation models were tested with maximum likelihood estimation and bootstrapping. RESULTS: Family strain was indirectly associated with chronic pain disease activity via biobehavioral reactivity-Model 1; χ²(10) = 40.75, p < .000, root mean square error of approximation [RMSEA] = .07, comparative fit index [CFI] = .96, standardized root-mean-square residual [SRMR] = .04; partial mediation occurred for partnered participants. This finding was replicated when modeling family strain simultaneously with intimate partner strain, though intimate partner strain was not associated with chronic pain disease activity-Model 2; χ²(5) = 8.29, p = .14, RMSEA = .03, CFI = .99, SRMR = .01. DISCUSSION: These findings add to the growing literature that emphasizes the role of family relationships in chronic pain. Future research is needed to replicate our use of the BBFM to specify pathways of effect, incorporating relational and observational data, with diverse samples. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Close relationships as a contributor to chronic pain pathogenesis: Predicting pain etiology and persistence.

RATIONALE: Chronic stress contributes to the pathogenesis of chronic pain. Yet, the role of close relationship stress in these pathways to pain is not fully understood. OBJECTIVE: To delineate specific psychosocial pathways associated with chronic pain, specifically emphasizing close relationships for midlife adults. We tested whether relationship strain, relationship support, social integration, depression, anxiety, and pain severity predict chronic pain etiology and persistence over 10 years, highlighting specific associations for acute versus chronic pain. METHOD: Using data from the National Survey of Midlife in the U.S. (MIDUS 2 and 3, collected in 2004-2006 and 2013-2014, respectively), we used logistic regression to test the etiology of new chronic pain (n = 1591) and persistence of pain for adults with acute (n = 352) and chronic pain (n = 367) conditions at baseline. RESULTS: Of participants who reported they did not have chronic pain at baseline, the development of chronic pain 10 years later was significantly associated with baseline family strain (OR = 1.38, p < .01). For participants with acute pain at baseline, the transition of this pain to chronic a decade later was significantly associated with initial reports of pain interference (OR = 1.24, p < .001), family support (OR = 0.60, p < .05), and depression (OR = 1.20, p < .05). Persistent chronic pain was solely associated with baseline pain interference (OR = 1.21, p < .01). CONCLUSIONS: Family strain is an important part of the chronic stress profile associated with chronic pain etiology, whereas family support is associated with a reduced risk of acute pain transitioning to chronic pain over time. Prioritizing family relationships in treatment approaches to pain may be an indicated, innovative approach to preventing pain development and escalation and requires systems training in healthcare.